Laparoscopic sigmoid colectomy and splenectomy for diverticulitis and splenic sarcoidosis

Abstract

Splenectomy together with colectomy is most commonly performed as a result of iatrogenic injury and not as an additional elective procedure. A 50-year-old African American female presented with recurrent episodes of diverticulitis. She had mediastinal, and porta hepatis lymphadenopathy and subcutaneous nodules, but multiple biopsies were unable to establish the diagnosis. On computed tomography scan, innumerable hypodense splenic lesions were noted. The patient underwent combined laparoscopic sigmoid colectomy and splenectomy. First, the severely inflamed sigmoid colon was mobilised followed by descending colon and splenic flexure. The spleen, which showed multiple granulomas, was dissected out and the hilum secured with a stapler. The rectum was now stapled, the Pfannenstiel incision was reopened, the spleen was removed in a retrieval bag and the colon was pulled out. The colorectal anastomosis was created with an end-to-end anastomotic (circular) stapler. Pathology demonstrated multiple non-caseating granulomas indicative for sarcoidosis and acute/chronic diverticulitis. The patient developed a superficial surgical site infection but no other complications. Prednisone and methotrexate were started and her sarcoidosis improved. She was well at her 2 years of follow-up. Only few patients have an indication for elective splenectomy together with segmental colectomy. The procedure can be safely performed using a laparoscopic approach.